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A Regular Discussion About Constipation

Dec. 7, 2022 3:08 pm

So, let's talk about constipation. Oooh. Is that a conversation inhibitor? Shouldn't be, as the importance of bowel movements is undeniable. So let's discuss what's normal, what's not normal, and the causes of constipation.

There are many causes of constipation. One could be a musculoskeletal problem where the muscles are tight in the pelvic floor region and it is not allowing the stool to pass. The second cause may be that the guts just aren't pushing the food through the digestive tract and it's not getting to where it needs to go to be eliminated. Another cause of constipation can be diet, as many foods slow the digestive tract (cheese and dairy products). There can be emotional causes as well.

The whole purpose of a bowel movement is to eliminate all of the by-products from our foods that are not used in our digestive system. If left in too long, they just don't feel good. They don't become toxic, but it does affect our other systems.

With eating food, it goes from our mouth to our stomach, from our stomach to our duodenum, from our duodenum to our small intestine, from our small intestine to our large intestine and then out through our sigmoid colon.

In that process there are many valves between the different organs: between the stomach and the duodenum, the duodenum and the small intestine, the small intestine and the large intestine. So sometimes the problem with pooping is that these valves aren't opening the way they should, so things are not able to pass and the valves are, for lack of a better word, "stuck." When they are not opening and closing like they should, food doesn't get to where it needs to go.

If you have a pooping problem, you are more than welcome to come to the PT Center for Women for evaluation. Through evaluation we can determine if it is diet related, visceral or gut valve related, or if it is musculoskeletal related-where the pelvic floor muscles aren't working properly to allow poop to come out of the body. It may be related to one, two, or all three of those things.

If it is a musculoskeletal problem of the pelvic floor, this is the area where we definitely can help. That is our forte; that is what we treat. The muscles of the pelvic floor should be strong enough to sphincter so you don't leak anything, but they should be able to relax enough to be able to have a normal bowel movement. If the muscles aren't strong enough, we strengthen them. If they are not relaxing enough, we either stretch them or release the tension through various techniques, including biofeedback.

Biofeedback is a modality where you use sensors on top of muscles or a rectal sensor inside the rectum to monitor what is going on with the rectal musculature. This is a good way to show patients whether they are contracting, whether they are relaxing, and what it feels like. It really does nothing to you, but it gives us feedback on what your muscles are doing so that you can better identify them, know what it feels like to relax to be able to have a bowel movement and what it feels like when the rectum is full.

Some of the information we gather from a patient that is constipated is a thorough intake including past medical history, medications, and bowel habits. This kind of information (how often you go, what it looks like) is important to the physical therapist to know where you are at in the beginning of physical therapy, so we know which tools to use to get to the normal bowel pooping pattern (which is every day, every other day, even up to every three days, snake length, round and soft without having to push).

Defecation or pooping is a normal, natural body process to eliminate waste products from our body. It always feels good to have a nice, large bowel movement. It is very healthy and a necessity in life. When this does not happen, however, patients are in pain, feel ill, and may end up in the ER. 

If you have issues with not being able to poop or you're not completely evacuating all the way, physical therapy can be beneficial.

Good conversation, right? A trifle one-sided, but it's a start.

Your turn. What questions do you have for me?

Connie Strey is a Physical Therapist at PT Center for Women, 3232 N Ballard Rd, Appleton, WI 54911. To make an appointment with Connie call or text 920.729.2982.

PT Center for Women is one of the only physical therapy centers in Wisconsin that specializes in pelvic pain and pelvic muscle dysfunction, offering women of all ages comprehensive evaluation and treatment for their physical therapy needs.

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